血栓弹力图在患儿凝血功能检测中的应用进展
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摘要
人类凝血系统在长期演变过程中,形成了1个复杂的动态平衡机制,这对维持机体稳态至关重要。而凝血系统的波动将导致严重疾病。众所周知,3—6月龄的婴儿凝血系统尚未完全成熟,新生儿及儿童生理性凝血与成人亦有所不同,新生儿常出现常规凝血试验指标异常。但其和临床症状之间的关系,如血栓形成或出血风险相关性依然不明确。人们对新生儿和儿童凝血功能的认识仍旧不足。血栓弹力图(thromboelastography,TEG)是血凝块形成动力学的描计图,能够反映血栓形成及降解的凝血过程全貌,属于血液流变学检测,一定程度上弥补了传统常规凝血试验的不足,为更好地评估患儿的凝血功能提供了有力保障。且相对常规凝血试验检查,TEG所需标本量小,适用于对儿科患者凝血状态的评估。
The human coagulation system is a complex, dynamic and balanced system, which is vital to maintain a good physical condition. While coagulation system in disorder may cause serious diseases. It is well-known that the coagulation system of infants aged from 3 to 6 months is not completely mature, and the physical coagulation in newborns and children are different from that of adults. Newborns often demonstrate abnormalities in conventional coagulation tests(CCTs). However, the relationship between the abnormalities and clinical symptoms remains unclear, such as the risk of thrombosis or bleeding. We are still insufficient understanding in coagulation function with newborns and children. Thromboelastography(TEG) is a laboratorial test that measures viscoelastic changes of the entire clotting process. It provides a more comprehensive global coagulation assessment than routine tests. Moreover, compared with CCTs, TEG requires a small amount of specimens, and it′s especially suitable for assessing the coagulation status of pediatric patients.
The human coagulation system is a complex, dynamic and balanced system, which is vital to maintain a good physical condition. While coagulation system in disorder may cause serious diseases. It is well-known that the coagulation system of infants aged from 3 to 6 months is not completely mature, and the physical coagulation in newborns and children are different from that of adults. Newborns often demonstrate abnormalities in conventional coagulation tests(CCTs). However, the relationship between the abnormalities and clinical symptoms remains unclear, such as the risk of thrombosis or bleeding. We are still insufficient understanding in coagulation function with newborns and children. Thromboelastography(TEG) is a laboratorial test that measures viscoelastic changes of the entire clotting process. It provides a more comprehensive global coagulation assessment than routine tests. Moreover, compared with CCTs, TEG requires a small amount of specimens, and it′s especially suitable for assessing the coagulation status of pediatric patients.
引文
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[3] 牟琼瑶:血栓弹力图形与凝血过程的研究.硕士:重庆理工大学;2018.
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[7] Adler M,Ivic S,Bodmer NS,et al.Thromboelastometry and Thrombelastography Analysis under Normal Physiological Conditions - Systematic Review.Transfus Med Hemother,2017,44 (2):78-83.
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[19] Pichler E,Pichler L.The neonatal coagulation system and the vitamin K deficiency bleeding - a mini review.Wien Med Wochenschr,2008,158 (13-14):385-395.
[20] Appel IM,Grimminck B,Geerts J,et al.Age dependency of coagulation parameters during childhood and puberty.J Thromb Haemost,2012,10 (11):2254-2263.
[21] Pal S,Curley A,Stanworth SJ.Interpretation of clotting tests in the neonate.Arch Dis Child Fetal Neonatal Ed,2015,100 (3):F270-274.
[22] Gernsheimer TB.Congenital and acquired bleeding disorders in pregnancy.Hematology Am Soc Hematol Educ Program,2016,2016 (1):232-235.
[23] Rahal H,Radouani M,Knouni H,et al.Deep vein thrombosis due to protein C deficiency in a neonate.Archives de pediatrie:organe officiel de la Societe francaise de pediatrie,2015,22 (10):1035-1038.
[24] Trenor CC,3rd.Thrombosis and thrombophilia:principles for pediatric patients.Blood Coagul Fibrinolysis,2010,21 (Suppl 1):S11-15.
[25] 王孟键,马曙轩,张慧敏,等.新生儿与儿童血栓弹力图结果比较.中国输血杂志,2018,31 (7):790-792.
[26] Sandrock-Lang K,Wentzell R,Santoso S,et al.Inherited platelet disorders.Hamostaseologie,2016,36 (3):178-186.
[27] Sutor AH.New aspects of vitamin K prophylaxis.Semin Thromb Hemost,2003,29 (4):373-376.
[28] von Kries R,Gobel U.[New aspects of vitamin K prophylaxis in newborn infants and infants] .Monatsschr Kinderheilkd,1986,134 (9):666-671.
[29] Romantsik O,Bruschettini M,Zappettini S,et al.Heparin for the treatment of thrombosis in neonates.Cochrane Database Syst Rev,2016,(11):CD012185.
[30] Hartert H.Blutgerinnungsstudien mit der Thrombelastographie,einem neuen Untersuchungsverfahren.Klinische Wochenschrift,1948,26 (37-38):577-583.
[31] 徐银霞,马丽琼.血栓弹力图的临床应用及研究进展.云南医药,2018,39 (1):72-73.
[32] 谭延国,张岩,王芳,等.TEG血栓弹力图同常规凝血试验的关系及TEG血小板图试验的临床应用.中国实验诊断学,2012,(1):81-85.
[33] Miller BE,Bailey JM,Mancuso TJ,et al.Functional maturity of the coagulation system in children:an evaluation using thrombelastography.Anesthesia & Analgesia,1997,84 (4):745-748.
[34] Karon BS.Why is everyone so excited about thromboelastrography (TEG) Clinica Chimica Acta,2014,436:143-148.
[35] 席朝运,于洋,陈麟凤,等.1766例创伤患者的临床用血调查分析.中国实验血液学杂志,2015,23 (1):228-233.
[36] Zambruni A,Thalheimer U,Coppell J,et al.Endogenous heparin‐like activity detected by anti‐Xa assay in infected cirrhotic and non‐cirrhotic patients.Scandinavian journal of gastroenterology,2004,39 (9):830-836.
[37] 赵凌,张敏,徐智杰,等.肝素酶纠正的血栓弹力图在胸心外科患者术后的应用.临床检验杂志,2014,32 (11):825-827.
[38] Klein SM,Slaughter TF,Vail PT,et al.Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin:a comparison with anti-Xa concentrations.Anesthesia & Analgesia,2000,91 (5):1091-1095.
[39] Radicioni M,Mezzetti D,Del Vecchio A,et al.Thromboelastography:might work in neonatology too?The Journal of Maternal-Fetal & Neonatal Medicine,2012,25 (Suppl 4):10-13.
[40] Whiting D,DiNardo JA.TEG and ROTEM:technology and clinical applications.Am J Hematol,2014,89 (2):228-232.
[41] Srivastava A,Brewer A,Mauser‐Bunschoten E,et al.Guidelines for the management of hemophilia.Haemophilia,2013,19 (1):e1-e47.
[42] Rosendaal F.Definitions in hemophilia,Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis Factor VII and Factor IX Subcommittee.2001.
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[44] van den Berg HM,De Groot PH,Fischer K.Phenotypic heterogeneity in severe hemophilia.J Thromb Haemost,2007,5 (Suppl 1):151-156.
[45] Tran H,S?rensen B,Bj?rnsen S,et al.Monitoring bypassing agent therapy–a prospective crossover study comparing thromboelastometry and thrombin generation assay.Haemophilia,2015,21 (2):275-283.
[46] Chitlur M,Warrier I,Rajpurkar M,et al.Thromboelastography in children with coagulation factor deficiencies.Br J Haematol,2008,142 (2):250-256.
[47] Young G,Blain R,Nakagawa P,et al.Individualization of bypassing agent treatment for haemophilic patients with inhibitors utilizing thromboelastography.Haemophilia,2006,12 (6):598-604.
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